Provider Demographics
NPI:1477940674
Name:DR. MARC LANDES LLC
Entity Type:Organization
Organization Name:DR. MARC LANDES LLC
Other - Org Name:DR. LANDES AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:LANDES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-606-2880
Mailing Address - Street 1:2234 CROSS CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1273
Mailing Address - Country:US
Mailing Address - Phone:330-606-2880
Mailing Address - Fax:
Practice Address - Street 1:905 SINGLETARY DR
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3975
Practice Address - Country:US
Practice Address - Phone:330-422-2168
Practice Address - Fax:330-422-2170
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. MARC LANDES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-25
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085936Medicaid